Renin Angiotensin System Blocker Fetopathy: A Midwest Pediatric Nephrology Consortium Report

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• 作者：Shahid Nadeem ; MD¹ ; ^{snadee@lsuhsc.edu" class="auth_mail" title="E-mail the corresponding author} ; Shireen Hashmat ; MD² ; Marissa J. Defreitas ; MD³ ; Katherine D. Westreich ; MD⁴ ; Ibrahim F. Shatat ; MD ; MS⁵ ; David T. Selewski ; MD⁶ ; Ali M. Onder ; MD⁷ ; Myra Chiang ; MD⁸ ; Donald J. Weaver Jr. ; MD ; PhD⁹ ; Julia Steinke ; MD ; MS¹⁰ ; John Barcia ; MD¹¹ ; Joel Hernandez ; MD¹² ; Guillermo Hidalgo ; MD¹³ ; Susan E. Ingraham ; MD ; PhD¹⁴ ; Carolyn L. Abitbol ; MD³ ; Cynthia Pan ; MD² ; Larry A. Greenbaum ; MD ; PhD¹⁵ ; ¹⁶
• 关键词：ACEI ; Angiotensin-converting enzyme inhibitor ; ARB ; Angiotensin II receptor blocker ; CNS ; Central nervous system ; eGFR ; Estimated glomerular filtration rate ; FDA ; US Food and Drug Administration ; RAS ; Renin angiotensin system ; RRT ; Renal-replacement therapy
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：167
• 期：4
• 页码：881-885
• 全文大小：381 K

文摘

Fetuses continue to be exposed to renin angiotensin system (RAS) blockers despite their known teratogenicity and a black box warning. We hypothesized that fetopathy from in utero exposure to RAS blockers has a broader spectrum of clinical manifestations than described previously and that there are a variety of clinical scenarios leading to such exposures.

Study design

This was a retrospective study performed through the Midwest Pediatric Nephrology Consortium. Cases of RAS blocker fetopathy were identified, with determination of renal and extrarenal manifestations, timing of exposure, and the explanation for the fetal exposure.

Results

Twenty-four cases were identified. RAS blocker exposure after the first trimester was associated with more severe renal manifestations. Chronic dialysis or kidney transplantation was required in 8 of 17 (47%) patients with RAS blocker exposure after the first trimester and 0 of 7 patients with exposure restricted to the first trimester (P = .05). Extrarenal manifestations, some not previously noted in the literature, included central nervous system anomalies (cystic encephalomalacia, cortical blindness, sensorineural hearing loss, arachnoid cysts) and pulmonary complications (pneumothorax, pneumomediastinum). RAS blocker exposure usually was secondary to absent or poor prenatal care or undiagnosed pregnancy.

Conclusion

RAS blocker fetopathy continues to be a cause of considerable morbidity, with more severe renal manifestations associated with exposure after the first trimester. A variety of significant extrarenal manifestations occur in these patients. Clinicians should emphasize the risk of fetopathy when prescribing RAS blockers to women of childbearing age.